Provider Demographics
NPI:1205281649
Name:BARLEY CORN HOLDINGS INC
Entity type:Organization
Organization Name:BARLEY CORN HOLDINGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-497-4937
Mailing Address - Street 1:521 W MONTE VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1122
Mailing Address - Country:US
Mailing Address - Phone:602-497-4937
Mailing Address - Fax:602-773-0910
Practice Address - Street 1:6909 W RAY RD
Practice Address - Street 2:SUITE 9
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1699
Practice Address - Country:US
Practice Address - Phone:602-497-4937
Practice Address - Fax:602-773-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty